Healthcare Provider Details

I. General information

NPI: 1154598704
Provider Name (Legal Business Name): MARIA ELENA RODRIGUEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N FULTON ST
FRESNO CA
93728-3404
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 559-488-4900
  • Fax: 559-488-4999
Mailing address:
  • Phone: 408-795-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberRN415092
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: